<form class="form-horizontal">
    <div class="form-group">
        <label class="col-sm-3 control-label" data-i18n-key="ProviderType">Provider Type</label>
        <div class="col-sm-9 col-md-9">
            <p class="form-control-static"><strong data-field="provider-type-name">WildFly 10</strong></p>
        </div>
    </div>

    <div class="form-group" data-field="provider-name-form">
        <div class="uf-form-label col-md-3 col-sm-3">
            <label class="control-label" data-field="provider-name-label" data-i18n-key="ProviderName">Provider Name</label>
        </div>
        <div class="col-sm-9 col-md-9">
            <input type="text" class="form-control" data-field="provider-name">
        </div>
    </div>

    <div class="form-group" data-field="host-form">
        <div class="uf-form-label col-md-3 col-sm-3">
            <label class="control-label" data-field="host-label" data-i18n-key="Host">Host</label>
        </div>
        <div class="col-sm-9 col-md-9">
            <input type="text" data-field="host" class="form-control">
        </div>
    </div>

    <div class="form-group" data-field="port-form">
        <div class="uf-form-label col-md-3 col-sm-3">
            <label class="control-label" data-field="port-label" data-i18n-key="Port">Port</label>
        </div>
        <div class="col-sm-9 col-md-9">
            <input type="text" data-field="port" class="form-control">
        </div>
    </div>

    <div class="form-group" data-field="management-port-form">
        <div class="uf-form-label col-md-3 col-sm-3">
            <label class="control-label" data-field="management-port-label" data-i18n-key="ManagementPort">Management Port</label>
        </div>
        <div class="col-sm-9 col-md-9">
            <input type="text" data-field="management-port" class="form-control">
        </div>
    </div>

    <div class="form-group" data-field="username-form">
        <div class="uf-form-label col-md-3 col-sm-3">
            <label class="control-label" data-field="username-label" data-i18n-key="UserName">Username</label>
        </div>
        <div class="col-sm-9 col-md-9">
            <input type="text" data-field="username" class="form-control">
        </div>
    </div>

    <div class="form-group" data-field="password-form">
        <div class="uf-form-label col-md-3 col-sm-3">
            <label class="control-label" data-field="password-label" data-i18n-key="Password">Password</label>
        </div>
        <div class="col-sm-9 col-md-9">
            <input type="password" data-field="password" class="form-control">
        </div>
    </div>

    <div class="form-group" data-field="test-connection-form-group">
        <div class="uf-form-label col-md-3 col-sm-3">
        </div>
        <div class="col-sm-9 col-md-9">
            <button class="btn btn-default" type="button" data-field="test-connection-button" data-i18n-key="TestConnection">TestConnection</button>
        </div>
    </div>

</form>
